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Wang J, Chen G, Chen H, Chen J, Su Q, Zhuang W. Exploring the characteristics of gut microbiome in patients of Southern Fujian with hypocitraturia urolithiasis and constructing clinical diagnostic models. Int Urol Nephrol 2023:10.1007/s11255-023-03662-6. [PMID: 37294502 DOI: 10.1007/s11255-023-03662-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/04/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Hypocitraturia is an important cause of urolithiasis. Exploring the characteristics of the gut microbiome (GMB) of hypocitriuria urolithiasis (HCU) patients can provide new ideas for the treatment and prevention of urolithiasis. METHODS The 24 h urinary citric acid excretion of 19 urolithiasis patients was measured, and patients were divided into the HCU group and the normal citrate urolithiasis (NCU) group. The 16 s ribosomal RNA (rRNA) was used to detect GMB composition differences and construct operational taxonomic units (OTUs) coexistence networks. The key bacterial community was determined by Lefse analysis, Metastats analysis and RandomForest analysis. Redundancy analysis (RDA) and Pearson correlation analysis visualized the correlation between key OTUs and clinical features and then established the disease diagnosis model of microbial-clinical indicators. Finally, PICRUSt2 was used to explore the metabolic pathway of related GMB in HCU patients. RESULTS The alpha diversity of GMB in HCU group was increased and Beta diversity analysis suggested significant differences between HCU and NCU groups, which was related to renal function damage and urinary tract infection. Ruminococcaceae_ge and Turicibacter are the characteristic bacterial groups of HCU. Correlation analysis showed that the characteristic bacterial groups were significantly associated with various clinical features. Based on this, the diagnostic models of microbiome-clinical indicators in HCU patients were constructed with the areas under the curve (AUC) of 0.923 and 0.897, respectively. Genetic and metabolic processes of HCU are affected by changes in GMB abundance. CONCLUSION GMB disorder may be involved in the occurrence and clinical characteristics of HCU by influencing genetic and metabolic pathways. The new microbiome-clinical indicator diagnostic model is effective.
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Affiliation(s)
- Jialiang Wang
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Licheng District Zhongshan North Road, Quanzhou, 362000, Fujian, China
| | - Guofeng Chen
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Licheng District Zhongshan North Road, Quanzhou, 362000, Fujian, China
| | - Heyi Chen
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Licheng District Zhongshan North Road, Quanzhou, 362000, Fujian, China
| | - Jiabi Chen
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Licheng District Zhongshan North Road, Quanzhou, 362000, Fujian, China
| | - Qingfu Su
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Licheng District Zhongshan North Road, Quanzhou, 362000, Fujian, China.
| | - Wei Zhuang
- Department of Urology, The Second Affiliated Hospital of Fujian Medical University, Licheng District Zhongshan North Road, Quanzhou, 362000, Fujian, China.
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Sulaksana TH, Kitching AR, Brown JJ, Gowdie P. Case of vertebral fracture with nephrolithiasis and hypocitraturia. J Paediatr Child Health 2022; 58:1097-1099. [PMID: 34676622 DOI: 10.1111/jpc.15770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Tania Hardja Sulaksana
- Department of Paediatric Rheumatology, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Arthur Richard Kitching
- Departments of Paediatric Nephrology and Nephrology, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Justin J Brown
- Department of Paediatric Endocrinology and Diabetes, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Peter Gowdie
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Departments of General Paediatrics and Paediatric Rheumatology, Monash Children's Hospital, Melbourne, Victoria, Australia.,Rheumatology Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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Perez-Suarez G, Yanes MIL, de Basoa MCMF, Almeida ES, García Nieto VM. Evolution of bone mineral density in patients with idiopathic hypercalciuria: a 20-year longitudinal study. Pediatr Nephrol 2021; 36:661-667. [PMID: 32980941 DOI: 10.1007/s00467-020-04754-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/06/2020] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several recent studies reported bone mineral density (BMD) reduction in pediatric patients with idiopathic hypercalciuria (IH). This longitudinal study aimed to evaluate BMD evolution in IH patients through three bone densitometry studies conducted over 20 years on average. A second objective was to evaluate urine calcium and citrate excretion during this period. METHODS Case notes of 34 patients diagnosed with IH at age 7.9 ± 3, alongside results of two bone densitometry studies, performed at 10.5 ± 2.7 (BMD1) and 14.5 ± 2.7 (BMD2) years of age, were reviewed. Patients underwent a third densitometry study in adulthood (BMD3) aged 28.3 ± 2.9. Mean follow-up duration (time-lapse between BMD1 and BMD3) was 17.7 ± 1.4 years. RESULTS Statistically significant differences were found between z-BMD3 (- 0.85 ± 1.10) and z-BMD1 (- 1.47 ± 0.99) (P = 0.001) as well as between z-BMD3 and z-BMD2 (- 1.33 ± 1.20) (P = 0.016). At the end of follow-up, z-BMD3 was superior to z-BMD2 in 23 adult patients (67.6%) and lower in 11 patients (5M, 6F; 32.3%). Both men and women showed increased bone mass over time, although such increases were significant only for women. The gradual decrease observed in calcium/creatinine and citrate/creatinine ratios could be related to improvement in osteoblastic activity and especially reduction in osteoclastic activity. CONCLUSIONS In patients with IH, BMD improves, which may be related especially to female sex, increment of body mass, and reduction in bone resorption. Upon reaching adulthood, urine calcium and citrate excretion tend to decrease so lithogenic risk still remains. The cause of the latter is unknown, although it likely relates to changes in bone activity.
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Affiliation(s)
- German Perez-Suarez
- Nephrology Department, Hospital Universitario Insular de Las Palmas de Gran Canaria, Las Palmas, Canary Islands, Spain.
| | - Ma Isabel Luis Yanes
- Pediatric Nephrology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain
| | | | | | - Víctor M García Nieto
- Pediatric Nephrology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain
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Bertholet-Thomas A, Guittet C, Manso-Silván MA, Castang A, Baudouin V, Cailliez M, Di Maio M, Gillion-Boyer O, Golubovic E, Harambat J, Klein A, Knebelmann B, Nobili F, Novo R, Podracka L, Roussey-Kesler G, Stylianou C, Granier LA. Efficacy and safety of an innovative prolonged-release combination drug in patients with distal renal tubular acidosis: an open-label comparative trial versus standard of care treatments. Pediatr Nephrol 2021; 36:83-91. [PMID: 32712761 PMCID: PMC7701073 DOI: 10.1007/s00467-020-04693-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/16/2020] [Accepted: 06/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Distal renal tubular acidosis (dRTA), due to impaired acid secretion in the urine, can lead to severe long-term consequences. Standard of care (SoC) oral alkalizers, requiring several daily intakes, are currently used to restore normal plasma bicarbonate levels. A new prolonged-release formulation, ADV7103, has been developed to achieve a sustained effect with an improved dosing scheme. METHODS In a multicenter, open-label, non-inferiority trial (n = 37), patients with dRTA were switched from SoC to ADV7103. Mean plasma bicarbonate values and proportion of responders during steady state therapy with both treatments were compared, as were other blood and urine parameters, as well as acceptability, tolerability, and safety. RESULTS When switching from SoC to ADV7103, the number of daily intakes was reduced from a median of three to twice daily. Mean plasma bicarbonate was increased and non-inferiority of ADV7103 was demonstrated (p < 0.0001, per protocol), as was statistical superiority (p = 0.0008, intention to treat [ITT]), and the response rate increased from 43 to 90% with ADV7103 (p < 0.001, ITT). Urine calcium/citrate ratio was reduced below the threshold for risk of lithogenesis with ADV7103 in 56% of previously non-responders with SoC (p = 0.021, ITT). Palatability was improved (difference [95% CI] of 25 [10.7, 39.2] mm) and gastrointestinal discomfort was reduced (difference [95% CI] of - 14.2 [- 25.9, - 2.6] mm) with ADV7103. CONCLUSIONS Plasma bicarbonate levels and response rate were significantly higher with ADV7103 than with SoC. Urine calcium/citrate ratio, palatability, and gastrointestinal safety were significantly improved, supporting the use of ADV7103 as first-line treatment for dRTA. TRIAL REGISTRATION Registered as EudraCT 2013-002988-25 on the 1st July 2013 Graphical abstract.
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Affiliation(s)
- Aurélia Bertholet-Thomas
- Centre de Référence des Maladies Rénales Rares - Néphrogones - Hôpital Femme Mère Enfant - Filière ORKiD, Hospices Civils de Lyon, Bron, France.
| | | | | | | | | | - Mathilde Cailliez
- Service de Pédiatrie Multidisciplinaire, Hôpital de la Timone, AP-HM, Marseille, France
| | - Massimo Di Maio
- Service de Réanimation Néonatale et Néonatologie, CHU de Nîmes, Nîmes, France
| | - Olivia Gillion-Boyer
- Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Institut Imagine, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Emilija Golubovic
- Klinički Centar Niš, Klinika za dečije interne bolesti - Odeljenje za nefrologiju, Niš, Serbia
| | - Jérôme Harambat
- Service de Pédiatrie, CHU de Bordeaux, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - Alexandre Klein
- Service de Néphrologie, Pôle DIACOR, Hôpitaux Civils de Colmar, Colmar, France
| | | | - François Nobili
- Service de Pédiatrie 2, Hôpital Jean Minjoz, CHU de Besançon, Besançon, France
| | - Robert Novo
- Service de Néphrologie Pédiatrique, Hôpital Jeanne de Flandre, CHRU de Lille, Lille, France
| | - Ludmila Podracka
- Department of Pediatrics, National Institute of Children's Health, Bratislava, Slovakia
| | - Gwenaëlle Roussey-Kesler
- Unité de Néphrologie et Hémodialyse Pédiatrique, Clinique Médicale Pédiatrique Hôpital Mère-Enfant, CHU de Nantes, Nantes, France
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Taguchi K, Hamamoto S, Okada A, Tanaka Y, Sugino T, Unno R, Kato T, Ando R, Tozawa K, Yasui T. Low bone mineral density is a potential risk factor for symptom onset and related with hypocitraturia in urolithiasis patients: a single-center retrospective cohort study. BMC Urol 2020; 20:174. [PMID: 33121459 PMCID: PMC7596945 DOI: 10.1186/s12894-020-00749-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/21/2020] [Indexed: 12/17/2022] Open
Abstract
Background Patients with urolithiasis have a lower bone mineral density (BMD) than those without stones, suggesting a potential correlation between calcium stone formation and bone resorption disorders, including osteopenia and osteoporosis. Methods To investigate the influence of BMD on clinical outcomes in urolithiasis, we performed a single-center retrospective cohort study to analyze patients with urolithiasis who underwent both BMD examination and 24-h urine collection between 2006 and 2015. Data from the national cross-sectional surveillance of the Japanese Society on Urolithiasis Research in 2015 were utilized, and additional data related to urinary tract stones were obtained from medical records. The primary outcome was the development of stone-related symptoms and recurrences during follow-up. A total of 370 patients were included in this 10-year study period. Results Half of the patients had recurrent stones, and the two-thirds were symptomatic stone formers. While only 9% of patients had hypercalciuria, 27% and 55% had hyperoxaluria and hypocitraturia, respectively. There was a positive correlation between T-scores and urinary citrate excretion. Both univariate and multivariate analyses demonstrated that female sex was associated with recurrences (odds ratio = 0.44, p = 0.007), whereas a T-score < − 2.5 and hyperoxaluria were associated with symptoms (odds ratio = 2.59, p = 0.037; odds ratio = 0.45, p = 0.01; respectively). Conclusion These results revealed that low T-scores might cause symptoms in patients with urolithiasis, suggesting the importance of BMD examination for high-risk Japanese patients with urolithiasis having hypocitraturia.
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Affiliation(s)
- Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan.
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan
| | - Yutaro Tanaka
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan
| | - Teruaki Sugino
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan
| | - Rei Unno
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan
| | - Taiki Kato
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan
| | - Keiichi Tozawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan
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Rodriguez A, Saez-Torres C, Mir C, Casasayas P, Rodriguez N, Rodrigo D, Frontera G, Buades JM, Gomez C, Costa-Bauza A, Grases F. Effect of sample time on urinary lithogenic risk indexes in healthy and stone-forming adults and children. BMC Urol 2018; 18:116. [PMID: 30567525 PMCID: PMC6299942 DOI: 10.1186/s12894-018-0430-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/10/2018] [Indexed: 11/12/2022] Open
Abstract
Background The diagnosis and follow-up of stone forming patients is usually performed by analysis of 24-h urine samples. However, crystallization risk varies throughout the day, being higher at night. The main objective of this study is to evaluate the urinary crystallization risk in adults and children by calculating risk indexes based on different collection periods. Methods The study included 149 adults (82 healthy and 67 stone-formers) and 108 children (87 healthy and 21 stone-formers). 24-h urine was collected, divided into 12-h daytime sample (8 am to 8 pm), and 12-h overnight sample (8 pm to 8 am next morning). Solute concentrations, the calcium to citrate ratio (Ca/Cit), and the ion activity product of calcium oxalate (AP[CaOx]) and calcium phosphate (AP[CaP]) were calculated in each 12-h sample and in overall 24-h urine. Assessments were also related to stone type. Results Ca/Cit and AP(CaOx) were significantly higher in stone forming patients than in healthy subjects. The 12-h overnight samples had the highest values for both risk indexes, confirming a greater risk for crystallization at night. The AP(CaP) index was significantly higher in patients with pure hydroxyapatite stones than healthy controls, but was not significantly different between stone-formers overall and healthy controls. Conclusions The calculation of risk indexes is a simple method that clinicians can use to estimate crystallization risk. For this purpose, the use of 12-h overnight urine may be a reliable alternative to 24-h collections.
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Affiliation(s)
- Adrian Rodriguez
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain
| | - Concepcion Saez-Torres
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain.
| | - Concepcion Mir
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain.,Department of Pediatric Nephrology, Son Espases Universitary Hospital, 07020, Palma de Mallorca, Spain
| | - Paula Casasayas
- Department of Urology, Son Llatzer Hospital, 07198, Palma de Mallorca, Spain
| | - Nuria Rodriguez
- Department of Urology, Son Llatzer Hospital, 07198, Palma de Mallorca, Spain
| | - Dolores Rodrigo
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain.,Department of Pediatric Nephrology, Son Espases Universitary Hospital, 07020, Palma de Mallorca, Spain
| | - Guiem Frontera
- Research Unit, Son Espases Universitary Hospital, 07020, Palma de Mallorca, Spain
| | - Juan Manuel Buades
- Department of Nephrology, Son Llatzer Hospital, 07198, Palma de Mallorca, Spain
| | - Cristina Gomez
- Clinical Analysis Service, Son Espases Universitary Hospital, 07020, Palma de Mallorca, Spain
| | - Antonia Costa-Bauza
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain
| | - Felix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain
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Kern A, Grimsby G, Mayo H, Baker LA. Medical and dietary interventions for preventing recurrent urinary stones in children. Cochrane Database Syst Rev 2017; 11:CD011252. [PMID: 29117629 PMCID: PMC6486163 DOI: 10.1002/14651858.cd011252.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Nephrolithiasis, or urinary stone disease, in children causes significant morbidity, and is increasing in prevalence in the North American population. Therefore, medical and dietary interventions (MDI) for recurrent urinary stones in children are poised to gain increasing importance in the clinical armamentarium. OBJECTIVES To assess the effects of medical and dietary interventions (MDI) for the prevention of idiopathic urinary stones in children aged from one to 18 years. SEARCH METHODS We searched multiple databases using search terms relevant to this review, including studies identified from the Cochrane Central Register of Controlled Trials (CENTRAL, 2017, Issue 1), MEDLINE OvidSP (1946 to 14 February 2017), Embase OvidSP (1980 to 14 February 2017), International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. Additionally, we handsearched renal-related journals and the proceedings of major renal conferences, and reviewed weekly current awareness alerts for selected renal journals. The date of the last search was 14 February 2017. There were no language restrictions. SELECTION CRITERIA Randomized controlled trials of at least one year of MDI versus control for prevention of recurrent idiopathic (non-syndromic) nephrolithiasis in children. DATA COLLECTION AND ANALYSIS We used standard methodologic procedures expected by Cochrane. Titles and abstracts were identified by search criteria and then screened for relevance, and then data extraction and risk of bias assessment were carried out. We assessed the quality of evidence using GRADE. MAIN RESULTS The search identified one study of 125 children (72 boys and 53 girls) with calcium-containing idiopathic nephrolithiasis and normal renal morphology following initial treatment with shockwave lithotripsy (SWL). Patients were randomized to oral potassium citrate 1 mEq/kg per day for 12 months versus no specific medication or preventive measure with results reported for a total of 96 patients (48 per group). This included children who were stone-free (n = 52) or had residual stone fragments (n = 44) following SWL. Primary outcomes:Medical therapy may lower rates of stone recurrence with a risk ratio (RR) of 0.19 (95% confidence interval (CI) 0.06 to 0.60; low quality evidence). This corresponds to 270 fewer stone recurrences per 1000 (133 fewer to 313 fewer) children. We downgraded the quality of evidence by two levels for very serious study limitations related to unclear allocation concealment (selection bias) and a high risk of performance, detection and attrition bias. While the data for adverse events were incomplete, they reported that six of 48 (12.5%) children receiving potassium citrate left the trial because of adverse effects. This corresponds to a RR of 13.0 (95% CI 0.75 to 224.53; very low quality evidence); an absolute effect size estimate could not be generated. We downgraded the quality of evidence for study limitations and imprecision.We found no information on retreatment rates. SECONDARY OUTCOMES We found no evidence on serum electrolytes, 24-hour urine collection parameters or time to new stone formation.We were unable to perform any preplanned secondary analyses. AUTHORS' CONCLUSIONS Oral potassium citrate supplementation may reduce recurrent calcium urinary stone formation in children following SWL; however, our confidence in this finding is limited. A substantial number of children stopped the medication due to adverse events. There is no trial evidence on retreatment rates. There is a critical need for additional well-designed trials in children with nephrolithiasis.
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Affiliation(s)
- Adam Kern
- Anne Arundel Medical CenterAnnapolisMDUSA
| | | | - Helen Mayo
- The University of Texas Southwestern Medical CenterUT Southwestern Library5323 Harry Hines BlvdDallasTXUSA75390
| | - Linda A Baker
- Children's Medical Center/University of Texas SouthwesternDepartment of Urology, Division of Pediatric UrologyDallasTXUSA75390
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Forni Ogna V, Blanchard A, Vargas-Poussou R, Ogna A, Baron S, Bertocchio JP, Prot-Bertoye C, Nevoux J, Dubourg J, Maruani G, Mendes M, Garcia-Castaño A, Treard C, Lepottier N, Houillier P, Courbebaisse M. Signification of distal urinary acidification defects in hypocitraturic patients. PLoS One 2017; 12:e0177329. [PMID: 28542241 PMCID: PMC5438111 DOI: 10.1371/journal.pone.0177329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/10/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hypocitraturia has been associated with metabolic acidosis and mineral disorders. The aim of this study was to investigate the occurrence of urinary acidification defects underlying hypocitraturia. MATERIALS AND METHODS This retrospective observational study included 67 patients (32 men), aged 40.7±15.1 years with hypocitraturia (<1.67 mmol/24-h) and nephrolithiasis, nephrocalcinosis, and/or bone demineralization, referred to our center from 2000 to 2015. We aimed to assess renal distal acidification capacity, prevalence and mechanisms of urinary acidification defects. Patients with low baseline plasma HCO3- (<22 mmol/L) were studied by bicarbonate loading or furosemide/fludrocortisone tests. Patients with normal baseline plasma HCO3- had an ammonium-chloride challenge test. A normal response was a decrease in urinary pH <5.3 and an increase in urinary NH4+ ≥33 μmol/min and defined idiopathic hypocitraturia. RESULTS Eleven patients (16.4%) had low HCO3- and overt distal acidification defect. Three had a mutation in the gene encoding AE1, 4 had Gougerot-Sjögren syndrome and no cause was found in the remaining 4 cases. Fifty-six patients (83.6%) had normal HCO3-; of those, 33 (58.9%) had idiopathic hypocitraturia. Among the 23 (41%) remaining patients, 12 were unable to increase urinary NH4+ excretion (among them, 8 were able to decrease urinary pH and 4 were not) whereas 11 were able to increase urinary NH4+ excretion but unable to decrease urinary pH. These 11 patients had higher fasting urinary calcium, reflecting bone resorption, than the other 12 patients: median 0.41 [0.24-0.47] vs. 0.22 [0.08-0.37] mmol/mmol creatinine (P = 0.04). CONCLUSIONS Patients with hypocitraturia and normal plasma HCO3- frequently show a latent acidification defect that can be further dissected into one of several subtypes based on urinary pH and NH4+ response to the acid load. Those patients with impaired urine acidification capacity but preserved NH4+ excretion exhibit particularly high calciuria and should be identified to optimize nephrolithiasis prevention.
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Affiliation(s)
- Valentina Forni Ogna
- Centre d’Investigations Cliniques, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Blanchard
- Centre d’Investigations Cliniques, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), Paris, France
- Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Rosa Vargas-Poussou
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), Paris, France
- Service de Génétique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Adam Ogna
- INSERM CIC 14.29, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Stéphanie Baron
- Université Paris Descartes, Faculté de Médecine, Paris, France
- Département de Physiologie, Unité rénale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Philippe Bertocchio
- Université Paris Descartes, Faculté de Médecine, Paris, France
- Département de Physiologie, Unité rénale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Prot-Bertoye
- Université Paris Descartes, Faculté de Médecine, Paris, France
- Département de Physiologie, Unité rénale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérôme Nevoux
- Service d’ORL, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris-Saclay, Paris, France
- INSERM 1182, Paris, France
| | - Julie Dubourg
- Centre d’Investigations Cliniques, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gérard Maruani
- INSERM CIC 14.29, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
- Institut Necker Enfants-Malades, INSERM U1151 –CNRS UMR 8253, Paris, France
| | - Margarida Mendes
- Centre d’Investigations Cliniques, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alejandro Garcia-Castaño
- Service de Génétique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cyrielle Treard
- Service de Génétique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nelly Lepottier
- Service de Génétique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pascal Houillier
- Université Paris Descartes, Faculté de Médecine, Paris, France
- Département de Physiologie, Unité rénale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR_S1138, CNRS ERL8228, Paris, France
| | - Marie Courbebaisse
- Université Paris Descartes, Faculté de Médecine, Paris, France
- Département de Physiologie, Unité rénale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut Necker Enfants-Malades, INSERM U1151 –CNRS UMR 8253, Paris, France
- * E-mail:
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9
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Al Kadhi O, Melchini A, Mithen R, Saha S. Development of a LC-MS/MS Method for the Simultaneous Detection of Tricarboxylic Acid Cycle Intermediates in a Range of Biological Matrices. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2017; 2017:5391832. [PMID: 29075551 PMCID: PMC5624170 DOI: 10.1155/2017/5391832] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/05/2017] [Indexed: 05/05/2023]
Abstract
It is now well-established that perturbations in the tricarboxylic acid (TCA) cycle play an important role in the metabolic transformation occurring in cancer including that of the prostate. A method for simultaneous qualitative and quantitative analysis of TCA cycle intermediates in body fluids, tissues, and cultured cell lines of human origin was developed using a common C18 reversed-phase column by LC-MS/MS technique. This LC-MS/MS method for profiling TCA cycle intermediates offers significant advantages including simple and fast preparation of a wide range of human biological samples. The analytical method was validated according to the guideline of the Royal Society of Chemistry Analytical Methods Committee. The limits of detection were below 60 nM for most of the TCA intermediates with the exception of lactic and fumaric acids. The calibration curves of all TCA analytes showed linearity with correlation coefficients r2 > 0.9998. Recoveries were >95% for all TCA analytes. This method was established taking into consideration problems and limitations of existing techniques. We envisage that its application to different biological matrices will facilitate deeper understanding of the metabolic changes in the TCA cycle from in vitro, ex vivo, and in vivo studies.
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Affiliation(s)
- Omar Al Kadhi
- Food and Health Programme, Quadram Institute Bioscience, Norwich NR4 7UA, UK
- Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Antonietta Melchini
- Food and Health Programme, Quadram Institute Bioscience, Norwich NR4 7UA, UK
| | - Richard Mithen
- Food and Health Programme, Quadram Institute Bioscience, Norwich NR4 7UA, UK
| | - Shikha Saha
- Food and Health Programme, Quadram Institute Bioscience, Norwich NR4 7UA, UK
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10
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Girón-Prieto MS, Arias-Santiago S, Del Carmen Cano-García M, Poyatos-Andújar A, de Haro-Muñoz T, Abad-Menor F, Quesada-Charneco M, Arrabal-Polo MÁ, Arrabal-Martín M. Bone remodeling markers as lithogenic risk factors in patients with osteopenia-osteoporosis. Int Urol Nephrol 2016; 48:1777-1781. [PMID: 27376897 DOI: 10.1007/s11255-016-1361-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/28/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To analyze the presence of phosphocalcic metabolism disorders in patients with osteopenia-osteoporosis without nephrolithiasis with respect to a control group. METHODS A cross-sectional study was conducted in patients with osteopenia-osteoporosis without nephrolithiasis (n = 67) in lumbar spine or femur and in a control group (n = 61) with no lithiasis or bone disorders. Blood bone markers, phosphocalcic metabolism, fasting urine, 24-h urine lithogenic risk factors, and densitometry were recorded in both groups. SPSS 20.0 was used for statistical analysis. RESULTS In comparison with the controls, significantly higher blood calcium (9.27 ± 0.36 vs. 9.57 ± 0.38, p = 0.0001), intact parathormone (45.6 ± 14.9 vs. 53.8 ± 18.9, p = 0.008), and alkaline phosphatase (61.9 ± 20.9 vs. 70.74 ± 18.9, p = 0.014) levels were found in patients with osteopenia-osteoporosis. In the 24-h urine test, citrate (1010.7 ± 647.8 vs. 617.6 ± 315.8, p = 0.0001) and oxalate (28.21 ± 17.65 vs. 22.11 ± 16.49, p = 0.045) levels were significantly lower in osteopenia-osteoporosis patients than in controls, with no significant difference in calcium (187.3 ± 106.9 vs. 207.06 ± 98.12, p = 0.27) or uric acid (540.7 ± 186.2 vs. 511.9 ± 167.06, p = 0.35) levels. Patients with osteopenia-osteoporosis had significantly higher levels of lithogenic risk factors associated with bone remodeling, including significantly increased β-crosslaps and osteocalcin values and higher β-crosslaps/osteocalcin ratios. CONCLUSION Patients with osteopenia-osteoporosis without nephrolithiasis showed phosphocalcic metabolism disorders as well as lower urinary citrate and higher β-crosslaps/osteocalcin and fasting calcium/creatinine ratios, which would increase the risk of nephrolithiasis. Hence, prospective studies are warranted to evaluate the long-term risks.
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Affiliation(s)
- María Sierra Girón-Prieto
- Centro de Salud de Pinos Puente, Programa de Doctorado de Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain
| | | | - María Del Carmen Cano-García
- UGC Urologia, Complejo Hospitalario Universitario Granada, Dr Virgili street, 9, bajo C. Huercal Overa, 04600, Granada, Spain.,Instituto IBS Granada, Granada, Spain
| | | | | | - Felix Abad-Menor
- UGC Urologia, Complejo Hospitalario Universitario Granada, Dr Virgili street, 9, bajo C. Huercal Overa, 04600, Granada, Spain.,Instituto IBS Granada, Granada, Spain
| | | | - Miguel Ángel Arrabal-Polo
- UGC Urologia, Complejo Hospitalario Universitario Granada, Dr Virgili street, 9, bajo C. Huercal Overa, 04600, Granada, Spain. .,Instituto IBS Granada, Granada, Spain.
| | - Miguel Arrabal-Martín
- UGC Urologia, Complejo Hospitalario Universitario Granada, Dr Virgili street, 9, bajo C. Huercal Overa, 04600, Granada, Spain.,Instituto IBS Granada, Granada, Spain
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11
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Akdeniz A, Caglayan MG, Anzenbacher P. A tri-serine tri-lactone scaffold for the quantification of citrate in urine. Chem Commun (Camb) 2016; 52:1827-30. [DOI: 10.1039/c5cc08759g] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tri-serine tri-lactone based fluorescent sensors can discriminate structurally similar anions, including mono-, di- and tri-carboxylates with 100% correct classification.
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Affiliation(s)
- Ali Akdeniz
- Department of Chemistry and Center for Photochemical Sciences
- Bowling Green State University
- Bowling Green
- USA
| | - Mehmet Gokhan Caglayan
- Department of Chemistry and Center for Photochemical Sciences
- Bowling Green State University
- Bowling Green
- USA
- Department of Analytical Chemistry
| | - Pavel Anzenbacher
- Department of Chemistry and Center for Photochemical Sciences
- Bowling Green State University
- Bowling Green
- USA
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12
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Calcium nephrolithiasis and bone demineralization: pathophysiology, diagnosis, and medical management. Curr Opin Urol 2015; 24:633-8. [PMID: 25188231 DOI: 10.1097/mou.0000000000000111] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To establish the relationship between calcium nephrolithiasis, bone densitometry scoring, and bone mineral density (BMD) loss according to bone turnover markers (BTMs) and urinary metabolites. RECENT FINDINGS Patients with recurrent calcium nephrolithiasis and idiopathic fasting hypercalciuria (urinary calcium/creatinine ratio >0.11) are more likely to have BMD loss that may lead to osteopenia or osteoporosis. In these patients, BTMs may be used as a surrogate for both bone health and stone recurrence. Suspect higher lithogenic states when calcium stone formers have serum beta-crosslaps (resorptive marker) greater than 0.311 ng/ml, serum osteocalcin (formative marker) greater than 13.2 ng/ml, and beta-crosslaps/osteocalcin ratio greater than 0.024. SUMMARY Patients with recurrent calcium nephrolithiasis and fasting hypercalciuria have a higher incidence of osteopenia and osteoporosis, measured by the dual-energy X-ray absorptiometry. These patients present not only with hypercalciuria and increased BTMs (mainly resorptive), but also up to 30% have hypocitraturia and increased urinary calcium/citrate ratio (>0.25). On the basis of these results, a diagnostic algorithm was created, classifying hypercalciurics according to their fasting calcium/creatinine and calcium/citrate ratio. Medical therapy for these patients is aimed at improving the dietary habits (normocalcemic, low salt, low animal protein diet), prescribing combinations of potassium citrate, thiazides, and bisphosphonates, and correcting bone and urinary abnormalities that may lower future skeletal and kidney stone risk.
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13
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Arrabal-Polo MA, Girón-Prieto MS, Cano-García MDC, Poyatos-Andujar A, Quesada-Charneco M, Abad-Menor F, Arias-Santiago S, Zuluaga-Gomez A, Arrabal-Martin M. Retrospective review of serum and urinary lithogenic risk factors in patients with osteoporosis and osteopenia. Urology 2015; 85:782-5. [PMID: 25817102 DOI: 10.1016/j.urology.2015.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/06/2015] [Accepted: 01/16/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To analyze differences in bone remodeling markers, lithogenic factors and bone densitometry among the 3 groups of patients (controls, patients with relapsing calcium renal lithiasis, and patients with loss of bone mineral density without lithiasis). MATERIAL AND METHODS This is a cross-sectional study including 203 patients who were divided in 3 groups: group 1 (controls), group 2 (patients with relapsing calcium renal lithiasis), and group 3 (patients with osteopenia and/or osteoporosis in the lumbar spine or hip). Bone densitometry, calcium-phosphorous and bone metabolism analysis, and analysis of lithogenic risk factors in fasting urine samples and 24-hour urine samples were performed. Statistical analysis was performed with SPSS 17.0. A P ≤.05 was considered statistically significant. RESULTS Patients in group 2 presented greater calcium excretion and a lower citrate excretion in 24-hour urine samples as compared with the other 2 groups. The proportion of hypercalciuria and hypocitraturia was higher in group 2. In addition, patients in group 2 presented a lower loss of bone mineral density as well as altered bone remodeling markers as compared with those in group 1. Patients in group 3 also presented alterations in urine calcium and citrate excretion with respect to the control group, with elevated fasting calcium and citrate levels and calcium-to-citrateratio. CONCLUSION Lithogenic risk factors are altered in patients with osteopenia and/or osteoporosis without renal lithiasis although to a lesser extent than patients with calcium renal lithiasis.
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Affiliation(s)
| | - María Sierra Girón-Prieto
- Centro de Salud de Atarfe, Spain; Programa de Doctorado de Medicina Clínica y Salud Pública, Universidad de Granada, Spain
| | | | | | | | - Felix Abad-Menor
- Servicio de Urología, Hospital Universitario San Cecilio, IBS Granada, Granada, Spain
| | | | - Armando Zuluaga-Gomez
- Servicio de Urología, Hospital Universitario San Cecilio, IBS Granada, Granada, Spain
| | - Miguel Arrabal-Martin
- Servicio de Urología, Hospital Universitario San Cecilio, IBS Granada, Granada, Spain
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14
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Arrabal-Martin M, Poyatos-Andujar A, Cano-García MDC, Quesada-Charneco M, Abad-Menor F, Girón Prieto MS, de Haro Muñoz T, Arrabal-Polo MA. The importance of calciuria as lithogenic factors in patients with osteopenia/osteoporosis. Int Urol Nephrol 2015; 47:445-9. [PMID: 25652872 DOI: 10.1007/s11255-015-0918-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Recurrent kidney stones are associated with bone mineral density loss, altered bone remodeling markers, hypercalciuria and increased in fasting calcium/creatinine ratio. The objective was to determine biochemical alterations in urine in patients with osteopenia/osteoporosis without calcium kidney stones compared with patients with calcium kidney stones. METHODS This is a cross-sectional study including 142 patients who were divided in two groups: Group 1 (patients with recurrent calcium kidney stones) and Group 2 (patients with osteopenia/osteoporosis in the lumbar spine or hip). Analyses of bone mineral density, calcium-phosphorous and bone metabolism and lithogenic risk factors in fasting urine samples and 24-h urine samples were performed. Statistical analysis was carried out with SPSS 17.0. A p ≤ 0.05 was considered statistically significant. RESULTS Patients in Group 2 presented greater loss of bone mineral density and more elevated alkaline phosphatase, iPTH, phosphorous and β-crosslaps levels, as compared to patients in Group 1. However, Group 1 presented greater urine calcium, oxalate and uric acid and a higher proportion of hypocitraturia, hypercalciuria and hyperoxaluria, as compared to Group 2. Multivariate analysis revealed that advanced age and β-crosslaps levels are risk factors for bone mineral density loss, while low urinary calcium excretion was protective against bone demineralization. CONCLUSION Patients with osteopenia/osteoporosis without lithiasis present some urinary biochemical alterations. This would explain the lack of lithogenic activity, although low calcium excretion in 24-h urine samples is a protective factor against the loss of bone mineral density.
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15
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Pacchiarotta T, Derks RJ, Nevedomskaya E, van der Starre W, van Dissel J, Deelder A, Mayboroda OA. Exploratory analysis of urinary tract infection using a GC-APCI-MS platform. Analyst 2015; 140:2834-41. [DOI: 10.1039/c5an00033e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study shows the first application of GC-APCI-MS in a clinical setting specifically in the context of urinary tract infection.
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Affiliation(s)
- Tiziana Pacchiarotta
- Center for Proteomics and Metabolomics
- Leiden University Medical Center
- Leiden
- The Netherlands
| | - Rico J. Derks
- Center for Proteomics and Metabolomics
- Leiden University Medical Center
- Leiden
- The Netherlands
| | - Ekaterina Nevedomskaya
- Center for Proteomics and Metabolomics
- Leiden University Medical Center
- Leiden
- The Netherlands
| | | | - Jaap van Dissel
- Department of Infectious Diseases
- Leiden University Medical Center
- Leiden
- The Netherlands
| | - André Deelder
- Center for Proteomics and Metabolomics
- Leiden University Medical Center
- Leiden
- The Netherlands
| | - Oleg A. Mayboroda
- Center for Proteomics and Metabolomics
- Leiden University Medical Center
- Leiden
- The Netherlands
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16
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Grimsby G, Mayo H, Jacobs MA, Baker LA. Medical and dietary interventions for preventing recurrent urinary stones in children. Hippokratia 2014. [DOI: 10.1002/14651858.cd011252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gwen Grimsby
- Children's Medical Center/University of Texas Southwestern; Department of Urology, Division of Pediatric Urology; Dallas TX USA 75207
| | - Helen Mayo
- The University of Texas Southwestern; UT Southwestern Library; 5323 Harry Hines Blvd Dallas TX USA 75390
| | - Micah A Jacobs
- Children's Medical Center/University of Texas Southwestern; Department of Urology, Division of Pediatric Urology; Dallas TX USA 75207
| | - Linda A Baker
- Children's Medical Center/University of Texas Southwestern; Department of Urology, Division of Pediatric Urology; Dallas TX USA 75207
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17
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Arrabal-Polo MÁ, Sierra Girón-Prieto M, Orgaz-Molina J, Zuluaga-Gómez A, Arias-Santiago S, Arrabal-Martín M. Calcium renal lithiasis and bone mineral density. Importance of bone metabolism in urinary lithiasis. Actas Urol Esp 2013; 37:362-7. [PMID: 23411066 DOI: 10.1016/j.acuro.2012.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 10/25/2012] [Indexed: 12/14/2022]
Abstract
CONTEXT Calcium Nephrolithiasis is a multifactorial disease; in its pathophysiology is involved various minerals and metabolic factors that may be altered, including bone and phosphor-calcium metabolism. OBJECTIVE To establish the scientific evidence and demonstrate the relationship between calcium nephrolithiasis and bone mineral density loss, through the use of bone turnover markers, serum and urinary metabolites. EVIDENCE ACQUISITION We performed a PubMed literature review using different MeSH Terms like "Nephrolithiasis", "Bone mineral density", "Urinary stones", "Calcium", Bone resorption" and "Bone formation", with different combinations. We only selected articles with abstracts in English or Spanish and discarded clinical cases and articles with inappropriate statistical study. A total of 40 articles were selected. EVIDENCE SYNTHESIS In different studies reviewed have been observed that patients with hypercalciuria have a higher bone mineral density loss with respect to normocalciuric. Among patients with calcium stones (normocalciuric or hypercalciuric), there is loss of bone mineral density, being more evident in patients with stones and hypercalciuria. This mineral density loss is marked and important in patients with recurrent calcium stones. Increased markers like fasting calcium/creatinine and β-CrossLaps are determinant of nephrolithiasis and mineral density loss in these patients. CONCLUSION We recommend perform markers of bone turnover and fasting calcium/creatinine in patients with recurrent calcium stones by the significant presence of bone mineral density loss, with a level of evidence III.
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Affiliation(s)
- M Á Arrabal-Polo
- Servicio de Urología, Hospital Universitario San Cecilio, Granada, España.
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